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Date��� N�o���wo���Po,m��. ,//� <br /> �Ia9 De�l.a �7 � ��Y 7 <br /> Application For <br /> PUBLIC WORKS PERMIT P°°T�,��«�F`c 5 <br /> Lnss AOa��Fae PaiO $ <br /> Balanca�ue $ <br /> Print or Type Only ' <br /> F�f�,N � YVI F��n cPn aal3 Gfh S7` E✓�inlf' 9�.za/ a5a-S0/� <br /> Owner <br /> Mailmg Address City Zip Phone <br /> Jp M e '— Zi Phone <br /> Applicant Mailmg Address City P <br /> Describe Proposed Work <br /> Frnn � r�nmlA la�i � Eitn rJl�� /'nrn^� <br /> � <br /> ProlectAddress�ifknowa) �'� � � t� �r_ � <br /> � <br /> Attach four(4)copies of plans lor proposed�,vork- Draw to scale antl nole the following as applicable: � <br /> � Property L.ines . O Centerline of street <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed strucWres on ihe tot • Show any proposed grading cl:anges <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1. pll calls for inspection shall be made 24 hrs. in advance• phone 259-881 5. <br /> 2. All work shall be performed in accordance with this permit and current City ot Everetl Design and Constructior. <br /> Standards and Specifications. � <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-8d0-424•5555. <br /> � s L�(o U / O <br /> f"L�BG/C G�O.C'�.J� /�E/�i��iT i✓L"�T �E(JUi,PE1J <'%7��"- <br /> � � <br /> . � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersi�ned owneUapplicant hereby agrees to hold and save harm- <br /> _ less Ihe City o( Everett (rom any and all cl�ims for damages, costs, <br /> expenses, or causes ol action that may arise because ol inslallation <br /> and maintenance ot the improvement or other right-obway use hereto <br /> applied lor and further agrees to remove same upon notice trom thn <br /> qpproved lor Co�struction �a1e City and to replace public prope!ty damaged thereby. <br /> FINAL INSPECTION �a�e Date <br /> Approved as Conslrucled SignaWre uf Applicanl <br /> WORK AUTHORIZED BY THIS PE(iM171T MUST BE STARTED WITHIN <br /> rverett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar S�reet gE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> EveretL WA 98201 CANCELLED BY THE CIiY UPON ANl'STOPPAGE OF WORK ON THIS <br /> Phone: 259-88:5 ppOJECT OVER 90 DAYS DURATION. <br />